Blood Borne Viruses and Sharps Injuries: In Care Homes

1. Blood Borne Viruses and Sharps Injuries: In Care Homes • Camilla Piper • Health Protection Nurse • South East London Health Protection Unit • Thanks to Mike King, Ann Baxter, Mandy Beaumont • and • Dr Nimal Premaratne • (Consultant in Communicable Disease Control)

2. Aims & Objectives • To inform delegates: • The different types of Blood Borne Viruses (BBV) • How to reduce the risks of cross-infection from these viruses • First aid measures following needlestick / contamination injury

3. BBV and Sharps Injuries • Outline of the Session • What are Blood Borne Viruses? • How are they spread? • What are the risks? • How can the risks be reduced? • Robust infection prevention & control strategies • Safe sharps management Staff immunisation • What are Sharps/Contamination injuries? • How to manage contamination incidents

4. Blood Borne Viruses (BBV) • These include • Hepatitis B • Hepatitis C • HIV / AIDS • (transmitted via contamination by blood or certain body fluids - e.g. blood, vaginal fluids, semen)

5. Body fluids that may contain HIV, Hepatitis B or Hepatitis C: • Blood • Blood stained body fluids • Semen • Vaginal secretions • Tissues CSF, amniotic, pericardial, pleural fluids • Body fluids that are less likely to contain pathogenic (disease causing) organisms: • Tears • Nasal secretions • Sweat • Saliva (more likely if blood present)

6. Blood Borne Viruses: Hepatitis B • SPREAD • By blood from someone who is infected with the virus getting into someone else's body: • * needlestick injuries • * through damaged or cut skin including bites • * by sharing needles and syringes • * from mother to baby around the time of birth • * through unprotected sexual intercourse • * through sharing razors and toothbrushes • * by tattooing, body piercing or acupuncture if instruments are not properly cleaned and sterilised

7. Blood Borne Viruses:Hepatitis C • SPREAD • By blood from someone who is infected with the virus getting into someone else's body: • * needlestick injuries • * IV drug use e.g sharing needles/syringes • Less common routes of infection: • * through damaged or cut skin including bites • * blood transfusions before screening (1989) • * sexual intercourse (less common) • * mother to baby around the time of birth • * sharing razors and toothbrushes • * tattooing, body piercing or acupuncture if instruments not properly sterilised

8. Blood Borne Viruses: HIV/AIDS • SPREAD • By blood from someone who is infected with the virus getting into someone else's body: • * needlestick injuries • * through damaged or cut skin including bites • * by sharing needles and syringes • * from mother to baby around the time of birth • * through unprotected sexual intercourse • * through sharing razors and toothbrushes • * by tattooing, body piercing or acupuncture if instruments are not properly cleaned and sterilised

9. How are BBV’s spread by blood/body fluids? • Needlestick injury (nb diabetic lancets) • Through damaged or cut skin

10. Spread of Infection BBVs (cont) • Blood borne viruses CANNOT be caught from: • coughing, sneezing • shared use of facilities such as toilets, water fountains or telephones • sharing glasses, plates and cutlery • shaking hands • swimming in a pool • if blood or body fluids fall onto intact skin • N.B For infection to be spread Infected blood (body fluid) • needs to enter body

11. Sharps / Contamination injuries.BBVs infection: * Inoculation of blood’ by contaminated needle/sharp piercing skin* Contamination of broken skin with blood* Splashes blood into mucous membranes e.g eyes mouth* Contamination where clothes soaked by blood* Bites (which break the skin)‘ blood & certain other body fluids

12. BBV’s - risk of transmission • Hepatitis B positive source - 1 in 3 • Hepatitis C positive source - 1 in 30 • HIV - 1 in 300 • (Estimated risk from person infected) • (UKED 1998) • Occupational risk (HCW) of acquiring BBV post exposure: • HIV 0.37% • HBV 20-40% • (Alder 1997)

13. What are the risks of infection? • * Risks vary for each person • * Assess on individual basis. • * Individual risks depend on • immunity • vaccination history • type of contact • exposure to and type of disease.

14. Minimising The Risks

15. Prevention of spread • Hep B • Vaccination is available • Universal or standard precautions • Hep C • No vaccination is available • Universal or standard precautions • HIV / AIDS • No vaccination is available • Universal or standard precautions

16. Prevention & control of BBV infections • Risk assessment (e.g glucose testing machines) • Standard Precautions • Education (BBV & sharps, safe lifestyle) • Sharps Management including • blood lancets • Vaccination and immunisation (at risk • groups: special learning needs,foster homes) • HCWs in contact blood / body fluids • Policy Development (handwashing, sharps (handling/disposal), dealing with blood/body fluid spillages, needlestick injury (first aid), using protective clothing (PPE), waste disposal, linen/laundry, cleaning)

17. Blood Borne Viruses: Protection • Prevention of infection / spread • Robust Infection Control Standards • e.g protective clothing, covering cuts, • waste disposal, cleaning, dealing with spills • Immunisation (Hepatitis B) • Sharps management

18. Standard Infection Control Precautions • Blood and body fluids • Remember: Diseases cannot be caught if blood or • body fluids fall onto intact skin. • Cover cuts and grazes with waterproof dressings. • Wear disposable gloves when handling any body fluids, including performing first aid eg for cuts • Dispose of used gloves, soiled tissues, dressings • as clinical waste.

19. Hepatitis B Immunisation For those at risk Occupational Risk groups • Healthcare workers • Staff / residents learning needs residential homes. • Police, prison staff • Commercial sex workers • Foster carers Others at risk • IV Drug users • Looked after children • Travellers to endemic areas • Partners acute cases • PEP etc. Vacccination programme • Three doses • Test for seroconversion 1-4 months after course completed

20. Management of Sharps • Training • Sharps policy eg use and handling • Disposal directly into sharps bin • Management of sharps bins • Do not overfill • Keep in safe place • Seal and label with source • Collect at clinical waste • Immunisation

21. Resheathing is a hazardous cess. The health care worker moves the used needle towards the resheathing cap … • Source: BMA booklet 1990 - • Code of Practice for the Safe Use and Disposal of Sharps Do not bend or recap needles • ...and misses, jabbing the hand holding the cap. Resheathing should be avoidedalways

22. Sharps / contamination injuriesNeedlesticks, blood into open cuts, bites or scratches (which draw blood) • FIRST AID: • encourage bleeding of any puncture wound • wash thoroughly with soap& water • cover with waterproof dressing • SPLASHES TO MOUTH OR EYES • Rinse thoroughly with plenty of running water • INFORM YOUR MANAGER IMMEDIATELY • Assess Risk • COMPLETE THE ACCIDENT / INCIDENT FORM (+ name of source if known) • GO TO A&E (Occupational Health Dept if applicable) if • significant injury • NB PEP (Post Exposure Prophylaxis) may be required

23. Hepatitis A NOT a Blood Borne Viruses (BBV) HAV is transmitted by the faeco-oral route. Person to-person spread is the most usual method of transmission, although contaminated food or drink may sometimes be involved.

24. Final thoughts! • Risk assess! Audit! • Decide the next steps • staff immunised? • training in safe handling? • (including use of diabetic lancing devices) • compliance with infection control? • Ensure there are agreed guidelines or • a policy for staff

25. THANK YOU • SOUTH EAST LONDON HEALTH PROTECTION UNIT • 1 Lower Marsh • London SE1 7NT • 020 7716 7030